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Gender issues in living organ donation: medical, social, and ethical aspects Silke Schicktanz, Mark Schweda & Sabine Wöhlke 1 Abstract The gender-disparity hypothesis for living kidney transplantation has been discussed for more than 20 years. It states that women donate kidneys more frequently than men, but fewer women than men receive organs. Our investigation aims at a) the quantitative verification of the genderdisparity -hypothesis in four European countries and b) the qualitative and ethical analysis of possible causes. Our quantitative analysis is based upon data for Germany, the Netherlands, Belgium and Austria provided by Eurotransplant for a five year period (2003–2007). On the recipient side, the higher number of men could be explained by statistically taking into account the sex-ratio for end stage renal disease. On the donor side, there is a significant difference between expected and observed numbers of women serving as donors in all four countries. Parents as living donors are the most important group to explain the deviation. Fathers donate to their children significantly less often and mothers more often than one would expect according to epidemiological data. To explore reasons behind these behavioural differences, we conducted and analysed focus group discussions in Austria, Germany and the Netherlands to gather information about attitudes and moral positions. Following the assumptions of the two-moralities debate, we found differences between men and women in their argumentation concerning (1) the formal structure of decision making and judgment (2), the role of the family for moral argumentation, and (3) the assessment of public institutions such as the state, the market and the medical system. Our findings indicate that gender related roles (and expectations) have a great impact on framing moral issues in organ transplantation while general moral attitudes are rather similar between men and women. We finally discuss consequences for clinical practice as well as for further research. Silke Schicktanz, Mark Schweda & Sabine Wöhlke 34 2 Introduction: is there a gender aspect in organ donation? Organ donation has complex medical, social, and ethical aspects. In this paper, we address sex and gender issues in organ transplantation, precisely, differences between men and women donating or receiving an organ. In many Western countries , about twice as many women as men donate a kidney. This fact, however, is still often neglected in medical and ethical overviews of organ transplantation. For the purpose of this paper, we focus on living organ donation, particularly on kidney transplantation: first, most evidence is available with regard to living organ donation (LOD). Though one can also observe a difference in sex of donors in post-mortem transplantation, this is yet not well investigated.1 3 Quantitative socio-demographical and medical data Second, in most countries, only the number of living kidney transplantations (LKD) is high enough to detect sex and gender related differences while living liver and lung transplantations are still too rare for gaining evidence with respect to an imbalance in the sexes. First, we will present statistical findings substantiating significant differences in the men/women ratio on the donor and on the recipient side; secondly, we will consider social and psycho-moral aspects of organ donation which interact with medical practice. Against this background, we will, thirdly, present socio-empirical data from focus group discussions with male and female potential donors exploring socio-cultural and moral factors for gender differences in donation. Finally, we discuss why and how gender issues should be addressed in the clinical setting. A variety of quantitative differences between men and women on several levels can be found in LKD. First and foremost, if we compare absolute numbers and sex proportion between donors and recipients we constantly observe a deviation from the normal population sex ratio (49% male vs. 51% female). (See table 1). However , it is necessary to analyse each side separately. On the recipient side, we statistically observe over time steady and over country rather stable differences – on average 37–41% are female patients and 59–63% male without high variations between different countries. (See table 1, first column, for an overview see also (2)) On the donor side, we observe differences in the sex ratio in various countries, too (see table 1, second column), but in this case there are much higher variations between different countries. In Germany, for instance, 61% of all living donors are female whereas only 39% are male. In Switzerland, the disparity is even more pro1 Interestingly, in post-mortem kidney transplantation, the ratio is reversed: In Germany, 46% of all donors...


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